| NPI | 1154913697 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN122969) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 7153) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 7153) | |
| Enumeration Date | 2021-02-05 |
| Last Update Date | 2024-04-11 |